Provider Demographics
NPI:1508909938
Name:KEN THOM COUNSELING INC
Entity Type:Organization
Organization Name:KEN THOM COUNSELING INC
Other - Org Name:KENNETH THOM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:660-562-2531
Mailing Address - Street 1:515 W COOPER
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2417
Mailing Address - Country:US
Mailing Address - Phone:660-562-2531
Mailing Address - Fax:660-562-3239
Practice Address - Street 1:515 W COOPER
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2417
Practice Address - Country:US
Practice Address - Phone:660-562-2531
Practice Address - Fax:660-562-3239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL CONGRESS OF CHURCHES AND MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002237101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24206013OtherBCBS PROVIDER
MO1912982893OtherNPI - PERSONAL PROVIDER
MO10001042101OtherCOMMUNITY HEALTH PLAN PRO
MO11633708OtherCAHQ
MO498635705Medicaid